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© 2008 Sudipto Das, Courtesy of PhotoshareAt USAID’s Mini University this year, adolescent health expert Dr. Robert Blum led a session titled, “Adolescent Health: How Far We Have Come, How Far We Have to Go.”  During this session, Dr. Blum explained how advancements in science, research and advocacy have improved adolescent health and, yet, how much work stills remains.  More than 2.6 million young people ages 10 to 24 die each year; among the 10 leading causes of death among this age group, six are socially determined.  Mental health issues are on the rise among young people; approximately 20% experience a mental health problem, and psychiatric disorders are the leading cause of disability among adolescents and young adults.  Approximately 5 million young people are living with HIV, and youth account for 40% of all new HIV infections. Rates of adolescent pregnancy are staggeringly high, with 16 million girls ages 15 to 19 giving birth every year. Both malnutrition and obesity are epidemic among youth and tobacco and alcohol use threaten the health of millions of young people.  Today’s generation of young people is the largest in history, and these young people face a variety of health challenges that deserve urgent attention.

How Far Have We Come?

The future of adolescent health is not in a state of despair; recent gains in science, research and advocacy have improved understanding of and attention toward adolescent health needs.  During his presentation, Dr. Blum highlighted the following:

  • We have a much richer sense of data related to adolescent health.
  • We have better research, including neurodevelopmental and genetic research.
  • We have improved conceptual models to guide our work.
  • We better understand the social determinants of health.
  • There is more global attention to adolescent health than ever before.

Through advancements in science, we have come to better understand adolescent brain development; we now understand how the brain continues to develop throughout the adolescent years, and how brain development affects adolescent health behaviors. We have a greater understanding of the role of genetics in health outcomes; we have learned that genetic factors alone only account for approximately 5% of disease, whereas most diseases are the combined result of biology and environment.  This has shaped our understanding of how to address adolescent health issues and has guided the development of conceptual models that address both risk and protective factors leading to today’s prevailing notion of positive youth development.

How Far Do We have to Go?

Despite these gains there is much more we need to do to fully address adolescent health. According to Dr. Blum we still need:

  • Better quality age-disaggregated data
  • Improved information on successful interventions
  • Improved advocacy
  • To move away from the unhelpful mindset of deterrence
  • To do the “do-able”

While data and information about adolescent health outcomes have improved much is lacking; specific information about young people is often hidden within national data sets.  Along with more data on adolescent health outcomes, we need more data on successful interventions. There is a lack of clarity about what the best approach to adolescent health is. Dr. Blum suggests we push the envelope; he stated that programs “have to have a high tolerance for failure or they are just not doing enough.”  We need not only to improve our programs but also to improve our advocacy efforts.  Finally, we need to continue to implement those programs that are working. Simple low-cost interventions that are proven successful can vastly improve the health of adolescents. These interventions include providing iron supplements,  promoting access to contraception, increasing school enrollment, offering life skills education,  encouraging hand washing,  and providing vaccination.  In the words of Dr. Blum, to achieve improved health outcomes among adolescents, we need to “do the do-able.”

Victoria Pascoe is a project associate at JSI where she works on issues relating to family planning and reproductive health. She is interested in sexual health and education and teaches a school-based health curriculum on puberty and adolescent development to 6th graders in Massachusetts.

The somewhat wary yet energetically charged group of 12-year-olds responds with a resounding “pituitary gland!”  The chorus dies down a bit and predictably becomes interspersed with giggles as we progress to body parts and reproductive anatomy in this “parroting” game we use to break the ice. When I ask if they know what the pituitary gland does I’m met by blank stares.  I explain that it is a small gland at the base of the brain; it releases hormones that trigger changes that occur during adolescence. For this brief overview of puberty, that’s as far as we delve into the role of the brain in the complex reaction of physical, cognitive and social changes that adolescents experience.

However, advances in neuroimaging technology over the past decade have shown that hormone production is just the tip of the iceberg in what is the complex and dynamic adolescent brain. Research* suggests that the prefrontal cortex — which is responsible for functions like impulse control, planning and decision-making, and risk assessment — continues to develop and mature throughout adolescence. These insights into the neurobiology of the adolescent brain are improving our understanding, shifting our conversations and informing how we relate to adolescents. This new knowledge is important for us to have about a stage of life that can be confusing for teens, who are weathering these changes, and also for their parents, who often struggle to understand and relate to them during this time.

Many resources have been produced to help parents and educators understand the implications of the new findings. Less has been said, however, about how this information translates in the health care setting. How can this information better inform the work of health care providers working with teens?  To address this need, JSI Research & Training Institute, Inc. (JSI) developed “Inside the Adolescent Brain: New Perspectives for Family Planning Providers,” an online course on the neurobiology of adolescent brain development to improve reproductive health care for adolescent patients.

Family planning providers sometimes feel mystified, discouraged, or frustrated in their work with young clients, and communication barriers threaten the open and honest dialogue that is essential to minimizing risky behaviors. This course guides providers though the interplay between sexual and neurological development, adolescent risk-taking behaviors and decision-making, and effective approaches for counseling and educating adolescent clients. For providers to successfully interact with teen clients, it is crucial that they reorient their expectations of adolescents, create a safe environment for care, and use adolescent-specific counseling and communication techniques.

JSI’s online course prepares family planning practitioners to support adolescents and effectively provide them with the health information they need to navigate this often tumultuous period. Facilitating improved communication and strengthening relationships in this way will not only result in improved health outcomes but also will foster positive experiences in the health care setting, for both practitioners and teens alike.

* For more information on this research, refer to The National Campaign to Prevent Teen and Unplanned Pregnancy’s Report – The Adolescent Brain: A Work In Progress

This course was funded by Office of Population Affairs/Office of Family Planning, U.S. Department of Health and Human Services and Centers for Disease Control and Prevention.)

The course is available for FREE on JSI’s eLearning Management Platform here

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This blog is brought to you by the Interagency Youth Working Group (IYWG) with financial assistance from the U.S. Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief. The content is managed by FHI, which functions as the secretariat for the IYWG.
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